Sexually transmitted infections (STIs) caused by Chlamydia trachomatis and Neisseria gonorrhoeae continue to be a major public health problem. Although they mainly affect the urogenital tract, N. gonorrhoeae and C. trachomatis can also be found in the pharynx and rectum. As data on extragenital chlamydia and gonorrhea in Bulgaria are still scarce, this study aimed to (1) determine the prevalence of pharyngeal and rectal infections with C. trachomatis and N. gonorrhoeae among men who have sex with men (MSMs) from Sofia and (2) to identify risk factors related to these infections to support screening recommendations based on scientific evidence. One hundred and fifteen MSM aged 16-50 were tested by systematic sampling during a visit to a sexual health center for voluntary and confidential HIV testing in Sofia. A questionnaire was used to collect demographics and risk factors, and clinical material from three anatomical sites: pharynx, rectum, and urogenital tract (first void urine or urethral swab) was examined to detect C. trachomatis and N. gonorrhoeae infections. The prevalence of C. trachomatis was 8.7% in the rectal samples tested, and the prevalence of N. gonorrhoeae was 0.9% and 5.2% in the pharyngeal and rectal samples, respectively. Local symptoms were reported in only 16.6% of rectal gonococcal infections and in 20% of C. trachomatis rectal infections. Patients reporting multiple partners had a significantly higher risk of being positive (OR = 3.8, 95% CI 1.03-14). The risk of HIV-positive MSM and those having unsafe sex was also higher (OR = 1.9 95% CI 0.19-20 and OR = 4.6 95% CI 0.98-21, respectively), but the findings were not statistically significant. Overall, more than 80% of extragenital infections would remain undetected and therefore transmissible if only symptomatic cases were investigated. These results suggest that in Bulgaria HIV-positive MSM and those having multiple sexual partners and unprotected sex would benefit from screening for extragenital STIs. Larger sample surveys could provide a better characterization of risk factors to guide screening choices.

Background: Telemedicine is an alternative to the standard consultation with a specialist during COVID-19 pandemic. Though their benefits are not well studied, the phone consultations are a potential effective resource for providing medical and psycho-social help to patients with chronic diseases during social isolation. Aim: To assess the demographic and clinical characteristics of patients, who looked for cardiology help on the phone, and the most common reasons for these consultations. Material and Methods: We analyzed the data of 196 consecutive patients with chronic cardiovascular diseases, who called for cardiology consultation at the National Patients’ Organization between 22.04.2020 and 31.07.2020. Results: The mean age of the included patients was 71,7 ± 11,3 years (17 ÷ 92), and 149 of them (76%) were above the age of 65 years (who we defi ned as elderly). 114 (58%) of the consulted on the phone were females. 96 patients (49%) called from Sofi a. The mean duration of the call was 8,5 minutes. The most common reasons for teleconsultation were unstable blood pressure – in 30% of the patients (n = 59) and anxiety – 17% (n = 33). Other reasons for seeking cardiology help were adjusting the therapy (different from the antihypertensive one) – 8%, chest pain – 7%, dyspnea – 7%, questions about follow-up of a chronic disease – 7%, palpitations – 6%, monitoring of INR – 4%, second opinion before an operation or a procedure – 2%, problems getting medications or protocols – 1,5%, administrative issues (TELK/LKK) – 1,5%. The most common chronic diseases of the consulted were: arterial hypertension (89%), heart failure (31%), ischemic heart disease (25%), diabetes mellitus (22%) and atrial fibrillation (15%). Conclusion: During COVID-19 pandemic the elderly and the women more often look for cardiology help on the phone. The suboptimal control of the blood pressure and the anxiety, caused by the pandemic, are the most common reasons for phone consultations of the patients with chronic cardiovascular diseases.

Although the spread of Lymphogranuloma venereum (LGV) among European men who have sex with men (MSM) has been endemic since 2003, to the author’s knowledge no LGV cases have been confirmed in Bulgaria up to date and treatment in suspected LGV patients has been presumptive due to lack of diagnostic capacity. The objective of the study was to genotype C. trachomatis-positive samples from attendees of a sexual health center in Sofia from 2020-2021 in order to be able to detect LGV circulation among MSM in Bulgaria. During the study period, a total of 246 MSM were tested with commercially available nucleic acid amplification tests (NAATs) to detect C. trachomatis in first void urine (FVU), pharyngeal and rectal swabs. Thirty-one consecutive clinical samples found positive for C. trachomatis during diagnostic testing were retrospectively analyzed for the presence of C. trachomatis serovars L1-L3. LGV genovars-specific C. trachomatis DNA was detected by pmpH PCR from the same specimen. LGV genovars were confirmed with partial ompA gene sequencing. Altogether 31 C. trachomatis-positive samples (22 FVU, 1 pharyngeal and 8 rectal swabs) were successfully typed by pmpH PCR. Twenty-nine samples contained non-LGV and two samples LGV C. trachomatis types. All the LGV types were found in rectal samples. Detected L types were confirmed to be serovar L2 with ompA sequencing. The data show that LGV circulate also among Bulgarian MSM, which underscores the importance of expanding LGV testing capacity in order to better inform patient management. Enhanced surveillance and genotyping programs could help measure and monitor LGV prevalence in Bulgaria.